- Discussion:
- by definition juvenile scoliosis develops before age 10;
- majority of idiopathic curvatures are right thoracic curves;
- left thoracic scoliosis is unusual;
- clinically, juvenile scoliosis shows slow progression prior to age 10, but after age 10 rapid progression may be found;
- diff dx of non progressive curve:
- spondyloepiphyseal dysplasia tarda:
- osteoid osteoma;
- infection;
- discitis;
- diff dx of progressive curve:
- tethered cord:
- Arnold Chiari malformation:
- hydromyelia:
- hydrocephalus:
- spinal tumor;
- syringomyelia:
- cervicothoracic syrinx associated with a Chiari type-I malformation at the foramen magnum has a significantly increased
prevalence in patients with idiopathic scoliosis, particularly those who exhibit a juvenile onset of this disorder;
- Chiari malformation and the syrinx could be the result of traction on the medulla distally through the foramen magnum;
- prevalence of a syrinx may range from 17 to 47 %;
- greater prevalence of left-sided thoracic deformity in patients with a syrinx;
- Radiographs:
- level of most rotated vertabra at the apex of the primary curve is an important predictor of prognosis;
- relative thoracic lordosis;
- rib vertebral angle:
- angle formed by perpendicular line from apical vertebral end plate and a second line from the mid-neck to mid-head of the adjacent rib;
- the rib vertebral angle difference is the difference between the two RVA on the concave and convex sides of the curve;
- a curve greater than 20 is considered progressive;
- reference:
The rib-vertebra angle in the early diagnosis betweeen resolving and and progressive infantile scoliosis.
- MRI:
- may be indicated in patients less than 11 years old, w/ left thoracic scoliosis, w/ neck pain, headaches, or neurologic findings;
- MRI will help rule out a syrinx, spinal tumor, or dural ectasia;
- Bracing:
- a good prognosis for successful bracing is a rib vertebral angle difference less than 10 deg in the brace;
- because juvenile curves are more flexible than their adult counterparts, curves of up to 60 deg can be managed in a brace;
- once patients enter the adolescent growth spurt, bracing is often ineffective;
- Surgical Treatment Options
- upto 25% to 50% of children w/ juvenile scoliosis will require fusion;
- note that posterior fusion in a physiologically young patient may lead to the crankshaft phenomenon
Childhood scoliosis: clinical indications for magnetic resonance imaging.
Infantile and juvenile idiopathic scoliosis before skeletal maturity.
MRI of 'idiopathic' juvenile scoliosis. A prospective study.
Orthopaedic aspects of intraspinal tumors in infants and children.
Diastematomyelia and structural spinal deformities.